Tuesday, July 16, 2013

Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus aureus Is Present among Industrial, Not Antibiotic-Free Livestock Operation Workers in North Carolina

Research Article

 

 

Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus aureus Is Present among Industrial, Not Antibiotic-Free Livestock Operation Workers in North Carolina

 

 

Jessica L. Rinsky equal contributor, equal contributor Contributed equally to this work with: Jessica L. Rinsky, Maya Nadimpalli

 

Affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America

 

X Maya Nadimpalli equal contributor, equal contributor Contributed equally to this work with: Jessica L. Rinsky, Maya Nadimpalli

 

Affiliation: Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, North Carolina, United States of America

 

X Steve Wing, Affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America

 

X Devon Hall, Affiliation: Rural Empowerment Association for Community Help (REACH), Warsaw, North Carolina, United States of America

 

X Dothula Baron, Affiliation: Rural Empowerment Association for Community Help (REACH), Warsaw, North Carolina, United States of America

 

X Lance B. Price, Affiliation: Department of Environmental and Occupational Health, George Washington University, Washington, District of Columbia, United States of America

 

X Jesper Larsen, Affiliation: Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark

 

X Marc Stegger, Affiliation: Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark

 

X Jill Stewart, Affiliation: Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, North Carolina, United States of America

 

X Christopher D. Heaney mail * E-mail: cheaney@jhsph.edu

 

 

Affiliations: Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America

 

 

 

 

 

Abstract

 

 

Objectives Administration of antibiotics to food animals may select for drug-resistant pathogens of clinical significance, such as methicillin-resistant Staphylococcus aureus (MRSA). In the United States, studies have examined prevalence of MRSA carriage among individuals exposed to livestock, but prevalence of multidrug-resistant S. aureus (MDRSA) carriage and the association with livestock raised with versus without antibiotic selective pressure remains unclear. We aimed to examine prevalence, antibiotic susceptibility, and molecular characteristics of S. aureus among industrial livestock operation (ILO) and antibiotic-free livestock operation (AFLO) workers and household members in North Carolina.

 

Methods Participants in this cross-sectional study were interviewed and provided a nasal swab for S. aureus analysis. Resulting S. aureus isolates were assessed for antibiotic susceptibility, multi-locus sequence type, and absence of the scn gene (a marker of livestock association).

 

Results Among 99 ILO and 105 AFLO participants, S. aureus nasal carriage prevalence was 41% and 40%, respectively. Among ILO and AFLO S. aureus carriers, MRSA was detected in 7% (3/41) and 7% (3/42), respectively. Thirty seven percent of 41 ILO versus 19% of 42 AFLO S. aureus-positive participants carried MDRSA. S. aureus clonal complex (CC) 398 was observed only among workers and predominated among ILO (13/34) compared with AFLO (1/35) S. aureus-positive workers. Only ILO workers carried scn-negative MRSA CC398 (2/34) and scn-negative MDRSA CC398 (6/34), and all of these isolates were tetracycline resistant.

 

Conclusions Despite similar S. aureus and MRSA prevalence among ILO and AFLO-exposed individuals, livestock-associated MRSA and MDRSA (tetracycline-resistant, CC398, scn-negative) were only present among ILO-exposed individuals. These findings support growing concern about antibiotics use and confinement in livestock production, raising questions about the potential for occupational exposure to an opportunistic and drug-resistant pathogen, which in other settings including hospitals and the community is of broad public health importance.

 

 

snip...

 

 

The results reported here show that the proportion of S. aureus identified as MDRSA and the proportion exhibiting phenotypic and molecular markers of livestock association was elevated among individuals exposed to the ILO environment compared to those exposed to the AFLO environment. Carriage of scn-negative MRSA CC398 and scn-negative MDRSA CC398 was limited to individuals with direct exposure to ILO production – all of these isolates were also resistant to tetracycline. Whether or not these livestock-associated S. aureus strains (including MRSA and MDRSA) pose a health risk to workers and the broader public requires further investigation. Overall, our findings support growing concern about antibiotic use and confinement in livestock production, and raise questions about the potential for occupational exposure to an opportunistic and drug-resistant pathogen which in other settings including hospitals and the community is a major cause of morbidity and mortality in the United States [4], [61] and globally [6], [7].

 

 

 

Citation: Rinsky JL, Nadimpalli M, Wing S, Hall D, Baron D, et al. (2013) Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus aureus Is Present among Industrial, Not Antibiotic-Free Livestock Operation Workers in North Carolina. PLoS ONE 8(7): e67641. doi:10.1371/journal.pone.0067641

 

Editor: Axel Cloeckaert, Institut National de la Recherche Agronomique, France

 

Received: February 19, 2013; Accepted: May 20, 2013; Published: July 2, 2013

 

Copyright: © 2013 Rinsky et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Funding: Funding for this study was provided by the North Carolina Translational and Clinical Sciences Institute, North Carolina Occupational Safety and Health Education and Research Center, the W.K. Kellogg Health Scholars Program – Community Track, and a Gillings Innovation Laboratory award from the UNC Gillings School of Global Public Health. CDH was supported by the W.K. Kellogg Health Scholars Program – Community Track, JLR by the National Institute of Environmental Health Sciences (NIEHS; award no. T32ES007018), and MN by a Royster Society fellowship and an EPA Science to Achieve Results fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

 

Competing interests: SW provided pro bono testimony in legal proceedings related to landfills and provided pro bono consultation on radiation and health for two law firms that made gifts to the University of North Carolina and another law firm that did not make a gift to the University of North Carolina. He conducted research on epidemiologic investigation of symptoms reported by neighbors of areas where sewage sludge is applied to land funded by the Water Environment Research Foundation. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

 

 


 

 

 

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Monday, April 18, 2011

 

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that MRSA is some nasty stuff. damn near killed me in 2001 after one of my neck surgeries. 8 weeks vancomycin via long PIC line. ...

 

 


 

 

 

 

TSS